This is the piece of paper I was given as a “formal” diagnosis back in 2001. It was the first time I learned about PTSD. It was also the first time I was misdiagnosed with Borderline Personality Disorder. In reality, my PTSD is severe, my current Dr told me it was one of the worst cases he had ever seen. But Dr. X, in his wisdom, after knowing me for a only a few months decided the impact of my trauma was “mild” and instead the main factor in my illness was untreated borderline personality disorder. As far as I can see, this assumtion was made due to my self cutting behaviour. He failed to take into account that before being abused I had no mental health problems. He failed to take into account that self harm and anorexia are common coping techniques for sexual abuse, especially in young women. He failed to notice that my out of control self harming behavior and suicide attempts began only AFTER taking a cocktail of psychiatric meds. He failed to see that I have almost none of the diagnostic criteria for BPD, except the self harm. I had long term friends, stable relationships in my life. I was not impulsive or risk seeking, except with regard to the self harm.
Over the next few months Dr X also placed a value judgment on this misdiagnosis of Borderline. He was the first person I talked to about the sexual abuse, and as such I trusted him and looked to him for support. This was a mistake. I didn’t have a choice as to what psychiatrist I saw, he was the one assigned to me. He gradually saw me less and less in his individual practice. I would show up for appointment only to find he had left for the day or was on call in the ER. Then he changed his practice to work solely in the urgent psychiatry clinic. The only way to get an appointment was through the ER.
I had no family Dr and nobody to renew, monitor or change my medications. He told all the psychiatrists at South Street that I was borderline and so they would not take me on as a patient. He refused to give me a referral to a community psychiatrist and I had no family doctor. I felt betrayed. I felt rejected. I felt worthless.
I started to use the ER on a regular basis, mainly after cutting myself. I would ask for a psych consult about 50% of the times I cut myself. I would ask the doctor on call to please assign me a regular psychiatrist to follow me. I begged. I pleaded. I was rejected. I was sometimes given an appointment at the urgent psychiatry clinic, where I knew I would see Dr. X again. No way to break free, systemic barriers and misdiagnosis kept me trapped. The more I protested, the more I harmed myself, the worse the situation got for me.
The treatment that I received at South Street was appalling. I know I am not the only one and I know this hospital is not the only one with issues. Women survivors of childhood sexual, emotional and physical abuse are often misdiagnosed with borderline, a diagnosis I see as basically a wastepaper basket label.
I remember during my second last year at South Street, 2003, I attempted suicide again. This time I cut myself extremely deeply, diagonally across my arm. I remember lying on the floor in the hallway of the apartment I shared with my boyfriend. I was dizzy, almost blacking out. I felt the quiet empty feeling in my head and I tried to decide whether or not to keep pressure on the cut or let it bleed and let myself give in to the pull of unconsciousness. I lay there for a while, I’m not sure how long. I finally decided to go to the hospital. I think I took a cab, but I’m not sure.
At the hospital, the medical doctor that first assessed me actually put me on a Form. He got a security guard to sit in my curtained area to watch over me. I remember I was studying for my 4th year Health Sciences exams. Somehow the irony of this was lost on me at the time. I had just tried to kill myself, I had a security guard watching me and I was studying for a university exam in the ER. The medical doctors fixed up my cut with stitches. By this time the routine of receiving stitches was, just that, routine. I had received hundreds, sometimes as many as 50 at a time. After I was fixed up I was transferred to the psych section of the ER. I don’t remember too much about what happened but I do remember I was told that there were no beds, that I could not be admitted. I told them that the cut had been a suicide attempt, not “just” self harming like I usually did. I begged to be admitted. But the psychiatry doctor was firm, there were no beds for me. I couldn’t understand it, the medical doctor had thought I was a risk to myself, so much so he had security watch over me, but psychiatry released me. I learned over the years at South Street that as soon as a doctor had access to my past charts I was treated very differently. I was generally taken seriously when a health care provider spoke to me and listened to me. When that same health care provider saw my chart, I was turned away, disrespected, ignored and mistreated. This is what misdiagnosis with BPD means to me.
I remember being discharged from the ER that day. I was desperate. I still wanted to die. I remember standing in between the double doors of the ER crying. I didn’t know where to go or what to do. I felt hopeless. It was late evening, it was spring or summer and it was still light outside. As I stood there crying a door opened, it led out to the ambulance bay right beside the place I was standing. Our of the door came a gurney, with a black body bag on it. The door led to the morgue which was also in the basement of South Street. The body was loaded into a funeral home vehicle and drove away. The image impacted me and haunted me. I wondered if my friend Darlene was wheeled out that very same door a year before. I was preoccupied with death. I felt scared and I felt lost. I just wanted someone to help me. I’m not even sure I really wanted to die at that point, I just wanted the pain and confusion to stop.
Eventually I left. I took the bus home, back to the apartment where I’d tried to end my life a few hours earlier.
I think that people often conclude that because an injury is self inflicted, that the person chose it. That they are not traumatized by it or impacted by it. But I believe that self inflicted trauma also needs to be recognized as a contributor to PTSD. I think that my experiences within the psychiatric system alone could have caused PTSD in a healthy person. In a person who was already traumatized they were that much more severe. Sometimes comfort and sympathy are not provided to self injuring people. We are treated as though we “knew better” and are essentially “wasting time and health care resources” or taking away care from those who “really need it.” I believe that every person who self harms would have chosen a different option if they felt they truly had a choice. Self harm isn’t cool, it’s not fun, it’s not something to envy or idolize. It’s dangerous, it’s terrifying, it is not glamorous in any way. It leaves lasting scars. Scars I will live with for the rest of my life, and scars that trigger memories of times in my life I would much rather forget. I get flashbacks around my self inflicted trauma in the same ways I do to the abuse inflicted on me by others. And because I was abused in the health care system the two are not distinct.
There is no easy solution to these problems. People who self harm need and deserve compassion. PTSD should be taken seriously and not dismissed as a disordered personality. PTSD is treatable. Believing survivors is the first step. Yes, this means as a society we all have to step up and acknowledge that violence and abuse is much more prevalent than we ever imagined. We need to collectively work to end victim blaming and shaming and fight rape culture. Because powerful white male doctors, with all their privileges, labeling my personality as disordered is rape culture. I became sick and disabled because of abuse; I’m not disordered, I am a survivor.